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Journal of Evaluation in Clinical... Jul 2024To identify the influence of teamwork, communication skills, and structural empowerment on providing patient-centered care among nurses in Eswatini.
AIMS
To identify the influence of teamwork, communication skills, and structural empowerment on providing patient-centered care among nurses in Eswatini.
DESIGN
A quantitative, cross-sectional survey was used.
METHODS
This survey conducted in Eswatini selected registered nurses working as full-time nurses with more than 3 months of working experience using convenience sampling. Different measures were adopted and used to collect data among 130 eligible nurses from February to March 2022. Data were analyzed using Statistical Program for Social Sciences version 26.0.
RESULTS
A total of 123 nurses responded in the study and the mean age was 31.05 years with a standard deviation of 5.49. The overall response rate was 94.6% in this study. Hierarchical multiple regression analysis revealed that teamwork (β = 0.236, p < 0.05) and communication skills (β = 0.328, p < 0.05) were significant predictors of the provision of patient-centered care among nurses.
CONCLUSION
Team-building exercises and management interventions to empower nurses should be established to improve the provision of patient-centered care among nurses. Nurses should be empowered to provide patient-centered care in health facilities by encouraging them to provide their input in management procedures and planning programs.
IMPACT
Clinical practice requires nurses to use effective communication skills and work as a team. Nursing care established on teamwork, respect, empathy, and communication skills allows patients to express their concerns and views in health facilities as they feel involved in care.
PATIENT OR PUBLIC CONTRIBUTION
No patient or public contribution in this paper. This study only involved registered nurses as health professionals.
PubMed: 38951985
DOI: 10.1111/jep.14003 -
Genome Biology Jul 2024The massive structural variations and frequent introgression highly contribute to the genetic diversity of wheat, while the huge and complex genome of polyploid wheat...
BACKGROUND
The massive structural variations and frequent introgression highly contribute to the genetic diversity of wheat, while the huge and complex genome of polyploid wheat hinders efficient genotyping of abundant varieties towards accurate identification, management, and exploitation of germplasm resources.
RESULTS
We develop a novel workflow that identifies 1240 high-quality large copy number variation blocks (CNVb) in wheat at the pan-genome level, demonstrating that CNVb can serve as an ideal DNA fingerprinting marker for discriminating massive varieties, with the accuracy validated by PCR assay. We then construct a digitalized genotyping CNVb map across 1599 global wheat accessions. Key CNVb markers are linked with trait-associated introgressions, such as the 1RS·1BL translocation and 2NS translocation, and the beneficial alleles, such as the end-use quality allele Glu-D1d (Dx5 + Dy10) and the semi-dwarf r-e-z allele. Furthermore, we demonstrate that these tagged CNVb markers promote a stable and cost-effective strategy for evaluating wheat germplasm resources with ultra-low-coverage sequencing data, competing with SNP array for applications such as evaluating new varieties, efficient management of collections in gene banks, and describing wheat germplasm resources in a digitalized manner. We also develop a user-friendly interactive platform, WheatCNVb ( http://wheat.cau.edu.cn/WheatCNVb/ ), for exploring the CNVb profiles over ever-increasing wheat accessions, and also propose a QR-code-like representation of individual digital CNVb fingerprint. This platform also allows uploading new CNVb profiles for comparison with stored varieties.
CONCLUSIONS
The CNVb-based approach provides a low-cost and high-throughput genotyping strategy for enabling digitalized wheat germplasm management and modern breeding with precise and practical decision-making.
Topics: Triticum; DNA Copy Number Variations; Genome, Plant; High-Throughput Nucleotide Sequencing; Genetic Markers; Alleles
PubMed: 38951917
DOI: 10.1186/s13059-024-03315-6 -
BMC Palliative Care Jul 2024National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the...
BACKGROUND
National palliative care plans depend upon stakeholder engagement to succeed. Assessing the capability, interest, and knowledge of stakeholders is a crucial step in the implementation of public health initiatives, as recommended by the World Health Organisation. However, utilising stakeholder analysis is a strategy underused in public palliative care.
OBJECTIVE
To conduct a stakeholder analysis characterising a diverse group of stakeholders involved in implementing a national palliative care plan in three rural regions of an upper-middle-income country.
METHODS
A descriptive cross-sectional study design, complemented by a quantitative stakeholder analysis approach, was executed through a survey designed to gauge stakeholders' levels of interest and capability in relation to five fundamental dimensions of public palliative care: provision of services, accessibility of essential medicines, palliative care education, financial support, and palliative care vitality. Stakeholders were categorised as promoters (high-power, high-interest), latent (high-power, low-interest), advocates (low-power, high-interest), and indifferent (low-power and low-interest). Stakeholder self-perceived category and knowledge level were also assessed.
RESULTS
Among the 65 surveyed stakeholders, 19 were categorised as promoters, 34 as advocates, 9 as latent, and 3 as indifferent. Stakeholders' self-perception of their category did not align with the results of the quantitative analysis. When evaluated by region and palliative care dimensions the distribution of stakeholders was nonuniform. Palliative care funding was the dimension with the highest number of stakeholders categorised as indifferent, and the lowest percentage of promoters. Stakeholders categorised as promoters consistently reported a low level of knowledge, regardless of the dimension, region, or their level of interest.
CONCLUSIONS
Assessing the capability, interest, and knowledge of stakeholders is a crucial step when implementing public health initiatives in palliative care. It allows for a data-driven decision-making process on how to delegate responsibilities, administer financial resources, and establish governance boards that remain engaged and work efficiently.
Topics: Humans; Palliative Care; Cross-Sectional Studies; Stakeholder Participation; Surveys and Questionnaires; Male; Female; Adult; Middle Aged
PubMed: 38951852
DOI: 10.1186/s12904-024-01427-1 -
BMC Primary Care Jul 2024Urinary tract infections (UTI) affect almost two-thirds of all women during their lives and many experience recurrent infections. There are evidence-based guidelines...
BACKGROUND
Urinary tract infections (UTI) affect almost two-thirds of all women during their lives and many experience recurrent infections. There are evidence-based guidelines from multiple international societies for evaluation and treatment; however, recent claims-based analyses have demonstrated that adherence to these guidelines is poor. This study seeks to understand the barriers experienced by U.S. primary care providers (PCPs) to providing guideline-based care for UTI and recurrent UTI (rUTI).
METHODS
Semi-structured interviews of 18 PCPs, recruited from the greater Los Angeles area, examined real-world clinical management of UTI/rUTI episodes, decisions to refer to subspecialty care, and resources guiding counseling and management. Grounded theory methodology served to analyze interview transcripts and identify preliminary and major themes.
RESULTS
Participants expressed the desire to obtain urine cultures for each cystitis episode, but felt pressured to make compromises by patient demands or barriers to care. PCPs had lower thresholds to empirical treatment if patients had a history of rUTIs, were elderly, or declined evaluation. Laboratory data was minimally utilized in clinical decision-making: urinalyses were infrequently considered when interpreting culture data. PCPs treated a broad set of urologic and non-urologic symptoms as UTI, even with negative cultures. PCPs did not feel comfortable initiating UTI prophylaxis, instead seeking specialist evaluation for anatomic causes. They were unaware of management guidelines, typically utilizing UpToDate® as their primary resource. Few evidence-based UTI prevention interventions were recommended by providers.
CONCLUSIONS
Low availability of succinct and clear professional guidelines are substantial barriers to appropriate UTI/rUTI care. Poor useability of clinical guidance documents results in substantial confusion about the role of preventative measures and additional diagnostic testing. Difficulties in patient access to care providers lead to expectations for presumptive treatment. Future studies are needed to determine if improved educational materials for providers and/or management algorithms can improve guideline concordance of UTI management.
Topics: Humans; Urinary Tract Infections; Physicians, Primary Care; Qualitative Research; Female; Guideline Adherence; Male; Practice Guidelines as Topic; Attitude of Health Personnel; Recurrence; Middle Aged; Adult; United States; Practice Patterns, Physicians'; Interviews as Topic; Referral and Consultation
PubMed: 38951826
DOI: 10.1186/s12875-024-02477-3 -
BMC Public Health Jun 2024Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect...
BACKGROUND
Many women in low- and middle-income countries, including Kenya, access antenatal care (ANC) late in pregnancy. Home pregnancy testing can enable women to detect pregnancy early, but it is not widely available. Our study explored the acceptability and potential of home pregnancy testing delivered by community health volunteers (CHV) on antenatal care initiation in rural Kenya.
METHODS
This study was part of a public health intervention to improve uptake and quality of ANC. Between November and December 2020, we conducted 37 in-depth interviews involving women who tested positive or negative for a urine pregnancy test provided by CHVs; CHVs and their supervisors involved in the delivery of the pregnancy tests; facility healthcare workers; and key informants. Using Sekhon et al.'s framework of acceptability, the interviews explored participants' perceptions and experiences of home pregnancy testing, including acceptability, challenges, and perceived effects on early ANC uptake. Data were analysed thematically in NVivo12 software.
RESULTS
Home pregnancy testing was well-received by women who trusted test results and appreciated the convenience and autonomy it offered. Adolescents cherished the privacy, preferring home testing to facility testing which could be a stigmatising experience. Testing enabled earlier pregnancy recognition and linkage to ANC as well as reproductive decision-making for those with undesired pregnancies. Community delivery of the test enhanced the reputation and visibility of the CHVs as credible primary care providers. CHVs in turn were motivated and confident to deliver home pregnancy testing and did not find it as an unnecessary burden; instead, they perceived it as a complement to their work in providing ANC in the community. Challenges identified included test shortages, confidentiality and safeguarding risks, and difficulties accessing facility-based care post-referral. Newly identified pregnant adolescents hesitated to seek ANC due to stigma, fear of reprimand, unwanted parental notification, and perceived pressure from healthcare workers to keep the pregnancy.
CONCLUSION
Home pregnancy testing by CHVs can improve early ANC initiation in resource-poor settings. Mitigating privacy, confidentiality, and safeguarding concerns is imperative. Additional support for women transitioning from pregnancy identification to ANC is essential to ensure appropriate care. Future research should focus on integrating home pregnancy testing into routine community health services.
Topics: Humans; Female; Kenya; Pregnancy; Prenatal Care; Adult; Patient Acceptance of Health Care; Adolescent; Young Adult; Rural Population; Pregnancy Tests; Community Health Workers; Qualitative Research; Interviews as Topic; Home Care Services
PubMed: 38951787
DOI: 10.1186/s12889-024-19254-7 -
NPJ Precision Oncology Jul 2024Early identification of IDH mutation status is of great significance in clinical therapeutic decision-making in the treatment of glioma. We demonstrate a technological...
Early identification of IDH mutation status is of great significance in clinical therapeutic decision-making in the treatment of glioma. We demonstrate a technological solution to improve the accuracy and reliability of IDH mutation detection by combining MRI-based prediction and a CRISPR-based automatic integrated gene detection system (AIGS). A model was constructed to predict the IDH mutation status using whole slices in MRI scans with a Transformer neural network, and the predictive model achieved accuracies of 0.93, 0.87, and 0.84 using the internal and two external test sets, respectively. Additionally, CRISPR/Cas12a-based AIGS was constructed, and AIGS achieved 100% diagnostic accuracy in terms of IDH detection using both frozen tissue and FFPE samples in one hour. Moreover, the feature attribution of our predictive model was assessed using GradCAM, and the highest correlations with tumor cell percentages in enhancing and IDH-wildtype gliomas were found to have GradCAM importance (0.65 and 0.5, respectively). This MRI-based predictive model could, therefore, guide biopsy for tumor-enriched, which would ensure the veracity and stability of the rapid detection results. The combination of our predictive model and AIGS improved the early determination of IDH mutation status in glioma patients. This combined system of MRI-based prediction and CRISPR/Cas12a-based detection can be used to guide biopsy, resection, and radiation for glioma patients to improve patient outcomes.
PubMed: 38951603
DOI: 10.1038/s41698-024-00632-8 -
Nature Communications Jun 2024Voluntary participation is a central yet understudied aspect of collaboration. Here, we model collaboration as people's voluntary choices between joining an uncertain...
Voluntary participation is a central yet understudied aspect of collaboration. Here, we model collaboration as people's voluntary choices between joining an uncertain public goods provisioning in groups and pursuing a less profitable but certain individual option. First, we find that voluntariness in collaboration increases the likelihood of group success via two pathways, both contributing to form more optimistic groups: pessimistic defectors are filtered out from groups, and some individuals update their beliefs to become cooperative. Second, we reconcile these findings with existing literature that highlights the detrimental effects of an individual option. We argue that the impact of an outside individual option on collaboration depends on the "externality" of loners - the influence that those leaving the group still exert on group endeavors. Theoretically and experimentally, we show that if collaboration allows for flexible group formation, the negative externality of loners remains limited, and the presence of an individual option robustly aids collaborative success.
Topics: Humans; Cooperative Behavior; Optimism; Male; Female; Adult; Group Processes; Young Adult; Choice Behavior
PubMed: 38951522
DOI: 10.1038/s41467-024-49779-9 -
AIDS and Behavior Jul 2024Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To...
Disclosing one's HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks™ intervention helped them. Participants' narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals' autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.
PubMed: 38951455
DOI: 10.1007/s10461-024-04406-y -
Applied Health Economics and Health... Jul 2024Rheumatoid arthritis (RA) is a progressive and debilitating disease, causing persistent joint pain that limits daily activities requiring long-term treatment. Newer...
INTRODUCTION
Rheumatoid arthritis (RA) is a progressive and debilitating disease, causing persistent joint pain that limits daily activities requiring long-term treatment. Newer targeted therapies expand RA treatment options, but their high cost necessitates a focus on cost effectiveness. To address this, we aim to conduct a cost-utility analysis of these newer RA pharmacotherapies to support evidence-based policy decision-making.
METHODS
We analyzed the cost-utility of sequential treatment with TNF-α, B cell and JAK-inhibitors compared with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) for RA treatment in methotrexate (MTX) nonresponders. We used a Markov model with lifetime horizon and 6-month cycles from an Indian health system perspective. Costs (INR 2022) and quality-adjusted life years (QALYs) were used to determine the incremental cost-effectiveness ratios (ICERs) at a cost-effectiveness threshold of India's gross domestic product (GDP) per capita (2022). We assessed uncertainty using univariate, probabilistic sensitivity, and scenario analyses.
RESULTS
Despite additional QALYs, TNF-α, B cell, and JAK inhibitors were not cost-effective for treating moderate-to-severe patients with RA unresponsive to csDMARDs (including MTX) in India, as increased costs outweighed their clinical benefits. ICERs ranged from 10,46,206 to 31,09,207 Indian Rupees in the base case analysis, exceeding three times India's GDP per-capita [approximately USD $13,287 to $39,487 and GBP £10,776 to £32,025]. Sensitivity analyses confirmed the results' robustness. Scenario analysis suggested that a cost reduction of over 75% in drug prices could make most of the interventions cost effective compared with csDMARDs.
CONCLUSIONS
TNF-α, B cell, and JAK-inhibitors are not cost-effective compared with csDMARDs for patients with RA who have not responded to MTX in India at the current prices. Cost-effectiveness estimates were highly influenced by drug pricing variations. Therefore, reducing the prices of these interventions could enhance affordability, potentially leading to their inclusion in publicly funded health programs.
PubMed: 38951442
DOI: 10.1007/s40258-024-00898-w -
Selection of an alternate cementitious mortar using ceramic tile dust waste: a hybrid MCDM approach.Environmental Science and Pollution... Jul 2024Selection of a suitable alternative material from a pool of alternatives with many conflicting criteria becomes a Multi-Criteria Decision Making (MCDM) problem. In the...
Selection of a suitable alternative material from a pool of alternatives with many conflicting criteria becomes a Multi-Criteria Decision Making (MCDM) problem. In the present study, ternary blended mortars were prepared using ceramic tile dust waste (CTD), fly ash (FA), and ground granulated blast furnace slag (GGBFS) as binder components. Crusher dust (CD) was used as a fine aggregate component. Binder to aggregate ratios of 1:3 and 1:1 were prepared considering suitable flow. A total of 16 mortar mixes were cast. These mortars were tested for various conflicting criteria compressive strength, flexural strength, porosity, water absorption, bulk density, thermal conductivity, specific heat, thermal diffusivity, and thermal effusivity whose weightages obtained were 29.09%, 20.08%, 12.77%, 10.60%, 8.74%, 6.74%, 5.54%, 4.47%, and 1.97%, respectively, as per AHP analysis. Later, considering these different criteria and alternate mortars, it was observed that a 1:1 mortar with 20% CTD, 30% FA, and 50% GGBFS (RC20F30G50) is found to be the suitable mortar with the highest relative closeness coefficient of 0.861 and the highest net outranking flow of 0.316 with respect to MCDM techniques: technique for order of preference by similarity to ideal solution (TOPSIS) and preference ranking organization method for enrichment of evaluations (PROMETHEE-II), respectively. The ranking of the mortar in both methods complies with the relative weightages of the criteria and the performance of the mortars with respect to the above criteria.
PubMed: 38951398
DOI: 10.1007/s11356-024-34130-y